23 Intravenous iron use for anaemia in pregnancy: evaluation of practice at a district general hospital in UK and literature review

Objectives To compare the efficacy, safety, and cost-effectiveness of Iron Sucrose (Venofer) and Iron Isomaltoside (Monofer) in the treatment of iron deficiency anaemia of pregnancy. Methods A retrospective review for our local maternity services was done for use of intravenous iron involving 24 pregnant women with iron deficiency anaemia. Cost of treatment was provided by the local business authority and the NHS Prescription Cost Analysis 2012 database. Results 80% of patients received oral iron as the first line. However, there was inadequate evidence of antenatal counselling and checking compliance. 15 patients were treated with Monofer at a cost of £847 per patient. 9 patients were treated with Venofer at a cost of £2721.74 per patient. On average women received Monofer later in pregnancy, 36 weeks compared to 31 weeks.In a small group of patients, mild adverse effects such as flushing and headache were seen with Monofer. However, these were self-limiting. Only one had severe HSR which was successfully managed. No adverse reactions were seen in the Venofer group. Conclusion Monofer replenishes iron stores faster than Venofer, offering a safe, convenient, cost-effective, single-dose therapeutic treatment for iron deficiency anaemia in pregnancy. However, it is not commonly used in pregnancy due to fear of hypersensitivity reaction. Simple adverse effects are mislabelled as hypersensitivity reactions. A management flow chart has been suggested after a multidisciplinary discussion to guide in case of such events. There is a scope to improve detection of anaemia as well as the use of oral iron. To improve detection and management of iron deficiency anaemia, we have also introduced a simple flow chart for doctors and midwives to follow in hospital and community. This study highlights being innovative, proactive and execution of ideas within wider multidisciplinary teams in community and hospital to improve patient experience, safety and management.